Palmo Anest

Triple Lumen Central Vein Catheter insertion under Image Intensifier.

A morbidly obese 50-ish lady weighing 140kg with necrotising fasciatis of the left leg. The initial wound debridement was done but we think that she'll need another debridement on the day I was last on call. He Hb (haemoglobin) was also on the low side at 8.3g%. We inserted a triple lumen thru her right subclavian vein in preparation of better monitoring of her fluid status. Subclavian route becouse she almost have no neck for Int. Jug. cathetherization.

This is the the check x-ray we got. The Triple lumen went up to the Rt. Int. Jugular. Very poor film.

I re-inserted the triple lumen at right subclavian again and we had this check x-ray. Again it went up to the internal jugular. We think 2 is enough and she is also started to grumble a lot by then. We decided to re-insert the triple lumen in the OT before the ortho team started the wound debridement and we can confirm the placement with Image Intensifier.

Under the image guidence, we clearly sawe our guide wire went up easily to the int. jug. if we change the direction making it turn down, it'll kink and made a half u-turn, or it went to the left side of the body. From that we think that there's a obstruction on the right side. We went on to set a triple lumen on the right subclavian and it went into the superior vena cava smoothly.


There must be some sort of an obstruction on the right side. With the some what widen mediasternum there.

posted by LT @ 7:12 PM